TOGETHER. BETTER HEALTH.
Winter 2019
Volume 20
No.1
Prenatal Care: Visits, Testing and Screenings When do I need to start having prenatal care appointments? You can start getting prenatal care as soon as you know you’re pregnant, but it's actually best to see a doctor BEFORE you get pregnant. Family planning is a good discussion to have with your physican during your annual check-up. But if that’s not possible, begin prenatal visits as soon as you know you're pregnant.
How often will I have prenatal care visits? The frequency of prenatal care visits depends on how far along you are in your pregnancy and how high your risk is for complications. Maternity is covered at 100% in-network The typical prenatal care schedule for someone who’s 18-35 years old and healthy is: • • •
Every 4 or 6 weeks for the first 32 weeks Every 2 or 3 weeks for the 32nd-37th weeks Every week from the 37th week until delivery
Your doctor might ask you to come in for check-ups more often if you have a high-risk pregnancy. First trimester prenatal testing Prenatal testing in the first trimester confirms the viability of your pregnancy and makes sure it’s off to a healthy start. Testing includes: • • • • • •
Your first ultrasound A urine test Diagnostic blood tests A pap smear First trimester prenatal genetic testing Chorionic villus sampling (aka CVS)
Second trimester prenatal testing Testing includes: • • • •
Amniocentesis, if needed Glucose challenge screening test Glucose tolerance test Mid-pregnancy ultrasound
Genetic Testing vs. Genetic Screening Genetic screening and genetic testing are terms that are often mentioned during prenatal visits, typically during the first and second trimesters. It's important to know the difference between genetic testing and genetic screening. •
Genetic screening is the diagnosis, prognosis, management, and prevention of genetic diseases for those patients who have no current evidence or manifestation of a genetic disease and those who have not been determined to have an inheritable risk of genetic disease. Genetic screening is not covered by the Health Plan. You should discuss the benefits and out-of-pocket costs with your physican.
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Genetic testing is the diagnosis and management of genetic diseases for those patients with current signs and symptoms and for those who have been determined to have an inheritable risk of genetic disease. Authorization is required for genetic testing.
Genetic screening and genetic testing both use laboratory tests to identify the presence of specific genes that may cause genetic disorders. Both of these involve the same medical procedures, but genetic testing has more rigid tests. The main difference between genetic screening and genetic testing can be explained in the reason why a certain person undergoes the medical procedure. If a person wants to be tested because of the possibility of having a disease due to the occurrence of such a disease within a certain age group or ethnic group, then one will be undergoing genetic screening, which is not covered by the Health Plan. However if a person may have the disease gene due to family history, then this person will undergo genetic testing and authorization is required.
Learn How to Control Asthma What is Asthma? Asthma is a disease that affects your lungs. It is one of the most common long-term diseases in children, but adults can have asthma, too. Asthma causes wheezing, breathlessness, chest tightness, and coughing at night or early in the morning. If you have asthma, you have it all the time, but you will have asthma attacks only when something bothers your lungs. In most cases, we don’t know what causes asthma, and we don’t know how to cure it. We know that if someone in your family has asthma you are more likely to have it.
How Can You Tell If You Have Asthma? It can be hard to tell if someone has asthma, especially in children under age 5. Having a doctor check how well your lungs work and check for allergies can help you find out if you have asthma. During a checkup, a doctor will ask if you cough a lot, especially at night. He or she will also ask whether your breathing problems are worse after physical activity or at certain times of year. The doctor will then ask about chest tightness, wheezing, and colds lasting more than 10 days. He or she will ask whether anyone in your family has or has had asthma, allergies, or other breathing problems. Finally, the doctor will ask questions about your home and whether you have missed school or work or have trouble doing certain things. The doctor may also do a breathing test, called spirometry, to find out how well your lungs are working by testing how much air you can breathe out after taking a very deep breath before and after you use asthma medicine. What Is an Asthma Attack? An asthma attack may include coughing, chest tightness, wheezing, and trouble breathing. The attack happens in your body’s airways, which are the paths that carry air to your lungs. As the air moves through your lungs, the airways become smaller, like the branches of a tree are smaller than the tree trunk. During an asthma attack, the sides of the airways in your lungs swell and the airways shrink. Less air gets in and out of your lungs, and mucus that your body makes clogs up the airways. You can control your asthma by knowing the warning signs of an asthma attack, staying away from things that cause an attack, and following your doctor’s advice.
When you control your asthma: • • • • •
you won’t have symptoms such as wheezing or coughing you’ll sleep better you won’t miss work or school you can take part in all physical activities you won’t have to go to the hospital
What Causes an Asthma Attack? An asthma attack can happen when you are exposed to “asthma triggers.” Your asthma triggers can be very different from someone else’s asthma triggers. Know your triggers and learn how to avoid them. Watch out for an attack when you can’t avoid your triggers. Some of the most common triggers are tobacco smoke, dust mites, outdoor air pollution, cockroach allergen, pets, mold, smoke from burning wood or grass, and infections like flu.
How Is Asthma Treated? To control your asthma take your medicine exactly as your doctor tells you and stay away from things that can trigger an attack. Not everyone with asthma takes the same medicine. You can breathe in some medicines and take other medicines as a pill. Asthma medicines come in two types— quick-relief and long-term control. Quick-relief medicines control the symptoms of an asthma attack. If you need to use your quick-relief medicines more and more, visit your doctor to see if you need a different medicine. Long-term control medicines help you have fewer and milder attacks, but they won’t help you if you are having an asthma attack. Asthma medicines can have side effects, but most side effects are mild and soon go away. Ask your doctor about the side effects of your medicines. Remember, you can control your asthma. With your doctor’s help, make an asthma action plan. Decide who should have a copy of your plan and where he or she should keep it. Take your long-term control medicine even when you don’t have symptoms.
More Information: https://www.cdc.gov/asthma/faqs.htm
What Happens During a Well-Child Visit? During a well-child visit, your doctor will: • • • • •
perform a physical exam give the child any necessary shots (immunizations or vaccinations) track how your child is growing and developing talk about illness prevention, diet and physical fitness, and health and safety issues talk about how to handle emergencies and sudden illness
Are Vaccines Safe? Vaccinations are an important part of your child’s wellchild visit. Some parents worry that these shots can lead to developmental disorders, such as autism. Researchers at the Centers for Disease Control and Prevention (CDC) have done a number of studies on vaccine use and autism, and they have never found a link between the two. Vaccines are not only safe, but also play an important role in keeping all children healthy.
Make sure your doctor isn’t doing all the talking. The wellchild visit is your best opportunity to bring up any worries about your child’s growth and development, especially if your child is not reaching important milestones. Remember, your doctor may be an expert in children’s health, but you are the expert on your child. Also, don’t be afraid to ask questions, medical or otherwise. Your child’s doctor can give you valuable advice on how to promote your child’s learning and development, how to potty train, tips on playground safety, and more. Well-child visits are paid at 100% when performed in-network. Recommended Doctor’s Visits The American Academy of Pediatrics has a recommended schedule of visits for children starting soon after they are born. You should visit a doctor for a well-child checkup:
THE BEST WAYS TO IMPROVE Y High Blood Pressure Threatens Your Health and Quality of Life In most cases, the damage done by high blood pressure (HBP, or hypertension) takes place over time. Left undetected (or uncontrolled), high blood pressure can lead to: • • • • • • • •
Heart attack: High blood pressure damages arteries which can become blocked and prevent blood flow to the heart muscle. Stroke: High blood pressure can cause blood vessels in the brain to clog more easily or even burst. Heart failure: The increased workload from high blood pressure can cause the heart to enlarge and fail to supply blood to the body. Kidney disease or failure: High blood pressure can damage the arteries around the kidneys and interfere with their ability to filter blood effectively. Vision loss: High blood pressure can strain or damage blood vessels in the eyes. Sexual dysfunction: High blood pressure can lead to erectile dysfunction in men or lower libido in women. Angina: Over time, high blood pressure can lead to heart disease or microvascular disease (MVD). Angina, or chest pain, is a common symptom. Peripheral artery disease (PAD): Atherosclerosis caused by high blood pressure can cause a narrowing of arteries in the legs, arms, stomach and head, causing pain or fatigue.
Your best protection is knowledge, management and prevention. •
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Know your numbers: The best way to know if you have high blood pressure is to have your blood pressure checked. Ideally, your blood pressure should be no higher than 120/80. Understand the symptoms and risks: Learn what factors could make you more likely to develop high blood pressure and put you at risk for serious medical problems. Make changes that matter: Take steps to reduce your risk and manage your blood pressure. Make hearthealthy lifestyle changes, take any medication as prescribed and work in partnership with your doctor.
High blood pressure and hypertensive crisis •
If your blood pressure readings suddenly exceed 180/120 mm Hg, wait five minutes and then test your blood pressure again. If your readings are still unusually high, contact your doctor immediately.
Non-Adherence to Statin Therapy: A Growing Concern in Prevention of Cardiovascular Disease (CVD) Poor adherence to statin therapy is linked to significantly increased risk of cardiovascular events and death. This is an alarming concern for patients prescribed potentially life-saving cholesterol-lowering medication, especially for those at high risk of cardiovascular events. Research on statin adherence has only recently garnered broader attention. Reasons for non-adherence to statin therapy need to be identified as well as suggestions for countermeasures. An integrated approach to minimizing barriers and enhancing facilitation at the levels of the patient, provider, and health system can help address adherence issues.
Health care professionals including physicians, pharmacists, and nurses have an obligation to improve patient adherence, as routine care. Role of Statins in the Prevention of CVD Since their introduction in 1987, statins have been considered one of the key interventions associated with the decline of cardiovascular morbidity and mortality. By lowering LDL-C, statins have significantly decreased cardiovascular events in both primary and secondary CVD prevention trials. Statins also help stabilize arterial plaques present in the blood vessels of the brain and heart, reducing the risk of stroke and Coronary Heart Disease related
More information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5973378/
events. Prescribing statins has increased as a result of expanding indications, guidelines emphasizing intensification of LDL-C lowering goals, rising number of generics, and recommendations on earlier screening and treatment. Clearly, statins have now become the universally accepted standard of atherosclerotic cardiovascular disease care, to the extent that clinical trials of new lipid-lowering drugs are being conducted as add-ons to statins rather than as novel stand-alone therapies. The benefits of statin therapy can only be realized if patients adhere to the prescribed treatment regimens.
YOUR CHANCES FOR SURVIVAL. Early Detection with Cervical and Breast Cancer Screenings
Diabetes: Types and Treatment
Importance of Being Screened for Cervical Cancer Cervical cancer was once one of the most common causes of cancer death for American women. The cervical cancer death rate dropped significantly with the increased use of the Pap test for screening. But the death rate has not changed much over the last 15 years. Screening tests offer the best chance to have cervical cancer found early when successful treatment is likely. Screening can also actually prevent most cervical cancers by finding abnormal cervical cell changes (pre-cancers) so that they can be treated before they have a chance to turn into a cervical cancer. Despite the recognized benefits of cervical cancer screening, not all American women get screened. Most cervical cancers are found in women who have never had a Pap test or who have not had one recently. Cervical cancer screenings are covered 100% in-network.
Diabetes is a condition that impairs the body's ability to process blood glucose, otherwise known as blood sugar. In the United States, the estimated number of people over 18 years of age with diagnosed and undiagnosed diabetes is 30.2 million. The figure represents between 27.9 and 32.7 percent of the population. Without ongoing, careful management, diabetes can lead to a buildup of sugars in the blood, which can increase the risk of dangerous complications, including stroke and heart disease.
Breast Cancer Screening Tests Breast cancer screening tests include a clinical breast exam and mammography. For some women at higher-than-average risk of breast cancer, breast MRI may also be used. Standard breast cancer screening tests are used to find breast cancer before it causes any warning signs or symptoms. Screening tests can find breast cancer early, when the chances of survival are highest. Regular screening tests (along with follow-up tests and treatment if diagnosed) increase your chances of surviving breast cancer. Mammograms A mammogram is still the best preventive action you can take in the fight against breast cancer. Scheduling a routine mammogram is an easy step toward good health. Mammograms are non-invasive x-ray pictures of the breast, which can help doctors detect breast cancer at its earliest, most treatable stages. The earlier the detection, the higher the success rate for treatment. Mammograms are covered at 100% in-network. • • •
From age 35-39, one during this five-year period From age 40-64, one every calendar year At age 65 and older, one every two consecutive calendar years
Follow Up After An Abnormal Finding On A Screening Test If screening finds something abnormal, it’s important to follow up without delay. If breast cancer is found, it’s best to be diagnosed and treated at the earliest possible stage. Follow up after an abnormal finding on a screening test may include a diagnostic mammogram, a breast MRI and/or a breast ultrasound. Know the Warning Signs The warning signs of breast cancer are not the same for all women. The most common signs include a change in the look or feel of the breast, a change in the look or feel of the nipple and nipple discharge. If You Find a Lump If you feel a lump in your breast, try not to panic or worry. Most lumps are not breast cancer, but something less serious, such as a benign (not cancer) breast condition. However, if you find a lump (or notice any change in your breast or underarm area), it's best to see a doctor to be sure it's not breast cancer.
Different kinds of diabetes can occur, and managing the condition depends on the type. Not all forms of diabetes stem from a person being overweight or leading an inactive lifestyle. In fact, some are present from childhood. There are several types of diabetes. Three major diabetes types can develop: type 1, type 2, and gestational diabetes. Type I diabetes: Also known as juvenile diabetes, this type occurs when the body fails to produce insulin. People with type I diabetes are insulindependent, which means they must take artificial insulin daily to stay alive. Type 2 diabetes: Type 2 diabetes affects the way the body uses insulin. While the body still makes insulin, unlike in type I, the cells in the body do not respond to it as effectively as they once did. This is the most common type of diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases, and it has strong links with obesity. Gestational diabetes: This type occurs in women during pregnancy when the body can become less sensitive to insulin. Gestational diabetes does not occur in all women and usually resolves after giving birth. How Often Do You Need the A1C Test? • Once every year if you have prediabetes • Twice a year if you have type 2 diabetes, you don't use insulin and your blood sugar level is consistently within your target range • Four times a year if you have type 1 diabetes • Four times a year if you have type 2 diabetes, you use insulin to manage your diabetes or you have trouble keeping your blood sugar level within your target range You may need more frequent A1C tests if your doctor changes your diabetes treatment plan or you begin taking a new diabetes medication.
Presorted Standard U.S. Postage PAID Southern, MD Permit No. 139
APWU Health Plan 799 Cromwell Park Drive, Suites K-Z Glen Burnie, MD 21061 www.apwuhp.com (800) 222-2798 In This Issue: • • • • • • • • • •
Prenatal Care: Visits, Testing and Screenings Learn How to Control Asthma What Happens During a Well-Child Visit? The Best Ways to Improve Your Chances for Survival High Blood Pressure Threatens Your Health and Quality of Life Non-Adherence to Statin Therapy: A Growing Concern in Prevention of Cardiovascular Disease (CVD) Early Detection with Cervical and Breast Cancer Screenings Diabetes: Types and Treatment What Are Virtual Visits? Health Risk Assessment
What Are Virtual Visits? As a member, you have the benefit of virtual visits from Amwell! Virtual visits enables live and scheduled or on-demand visits on a computer, tablet or mobile device between you and a doctor. You can get medical care just as you would in a regular exam room, except you can now connect with a doctor by using a computer, tablet or phone. Save time by seeing a doctor in the comfort of your home, workplace, or anywhere you may be. Amwell is perfect for providing you or a family member with quality care, without all the hassle of taking a trip to the doctor’s office.
Health Risk Assessment Complete your Health Risk Assessment (HRA) online annually at www.apwuhp.com by clicking on the blue box that says, "Take A Health Risk Assessment" in the middle of the homepage. The HRA is an online program that analyzes your health-related responses and gives you a personalized plan to achieve specific health goals. Your HRA profile provides information to put you on a path to good physical and mental health.
APWU Health Plan members pay a reduced copay of $15 for using virtual visits through Amwell. Commonly Treated Conditions: • • • • • •
Flu Pink Eye Sinus Infection Strep Throat UTI Common Cold
For information on virtual visits, please visit www.AmWell.com.
Visits Anywhere Visits Anywhere
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Doctors available 24 hours a day, 365 days aDoctors year. available 24 hours a day, 365 days a
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Quality Care Quality Care
Board-certified Board-certified doctors, doctors,therapists, therapists,and and spespecialists with an average of 20 years cialists with an average of 20 years’ experience.
experience.
What are the benefits of the HRA? • • • • •
Provides members with a snapshot of their current health status Offers potential to monitor individual health status over time Provides members with concrete information that will prepare them for lifestyle changes Helps individuals get involved with health coaching Offers dental care discounts through CignaPlus Savings